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New Recommendations For Pain Management Among Active Military And Veterans

CJ Arlotta | Forbes

Much of the conversation around managing chronic pain has been directed toward the general U.S. population. One specific group deserves a little more attention: active military and veterans.

The National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health (NIH), this week delivered its recommendations for assisting military veterans with pain management. A working group from the center’s advisory council administered the report.
The group’s findings were prepared after a series of five meetings. During these engagements, the council listened to presentations by experts in various backgrounds: pain research, study design, complementary and integrative approaches. The Department of Defense (DOD) and the Department of Veterans Affairs (VA) gave input on initiatives, practices and priorities. Leaders from several veterans organizations also addressed the group.

The working group recommended that large-scale collaborative research into pain management for U.S. veterans should do the following: assess the impact of pain on patient function and quality of life as primary outcome measures, with changes in the use of opioids and other drugs as a secondary outcome; evaluate an integrated package of non-drug treatments, an integrative model of care, or a holistic approach to care rather than focusing on individual complementary health approaches; focus on patients in the early stages of chronic pain; leverage natural experiments and existing resources whenever possible; and be pragmatic and embedded in the delivery of care.

“I think these recommendations are very important, and I sincerely hope the people who can bring them to fruition pay heed to them,” said Bob Twillman, executive director of the American Academy of Pain Management, in an interview.

He believes the Interagency Pain Research Coordinating Council and the NIH Pain Consortium should use this research “as a cue to see if there are ways to apply these ideas in a civilian population, as well.”

Dr. Josephine P. Briggs, director of the NCCIH, told Forbes in an interview that additional research on chronic pain treatment for both the general public and within the military population is needed. A 2011 report conducted by the Institute of Medicine revealed that more than 100 million Americans are suffering from chronic pain. According to a study published last year in JAMA Internal Medicine, a peer-reviewed medical journal published by the American Medical Association, 44 percent of U.S. military members have reported chronic pain after returning home from deployment. 

“Many rely on opioids to manage pain,” Briggs said. There were more than 16,235 deaths involving prescription opioids in 2013, an increase of 1% from 2012. These numbers are concerning to many, including President Obama. The president’s drug control priorities for the 2016 fiscal year include reducing prescription drug abuse by allocating additional funding to states with prescription drug monitoring programs (PDMPs), expanding and improving treatment for addicts, and spearheading efforts to make naloxone — an opioid antagonist — more readily available to first responders.

“While these drugs are key to managing certain types of pain, such as acute pain following surgery, the use for chronic, long-term pain can become problematic,” Briggs said. “Thus, our research collaborations are focusing on non-drug approaches for managing pain.”

Twillman in a previous interview suggested the following alternatives to ingesting prescription opioids for pain management: accupuncture, chiropractic, psychotherapy and physical therapy. He believes expanding access and providing reimbursement for these alternative methods will bring down prescription opioid abuse. In order for this to happen, however, prescribers will need to become better educated on alternatives to prescription opioids for pain management. 

Managing pain within the military population can be little more complex, Briggs noted. For example, many returning service members have co-existing conditions such as PTSD, traumatic brain injury, drug addiction and sleep disorders.

“The logical next step for NCCIH is to assess the feasibility of undertaking one or more large-scale studies in cooperation with the VA and the DOD to answer core policy and patient care questions about the use of integrative approaches in pain management,” she said. “NCCIH has a growing intramural research program and a robust extramural portfolio in pain research and we have experience in real-world research through our work with the NIH Healthcare Systems Research Collaboratory and our work with the Patient-Centered Outcomes Research Institute (PCORI).”

Physical Well-Being